Healthcare Provider Details

I. General information

NPI: 1104430958
Provider Name (Legal Business Name): CLEARWATER FL OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 SUNSET POINT RD
CLEARWATER FL
33765-1132
US

IV. Provider business mailing address

440 SYLVAN AVE STE 240
ENGLEWOOD CLIFFS NJ
07632-2700
US

V. Phone/Fax

Practice location:
  • Phone: 727-443-1588
  • Fax:
Mailing address:
  • Phone: 201-928-7808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BATYA GORELICK
Title or Position: VP OF ADMINISTRATIVE SERVICES
Credential:
Phone: 201-928-7808